4 Reasons for Knee Pain During Cycling

Although cycling is considered a low-impact sport, many cyclists will end up with knee pain at some point in their training. There are so many factors at play in regards to the bike itself, your body in motion, and how the two interact. It can be hard to isolate the cause of your knee pain, but understanding the location of the pain and potential causes can help you avoid future occurrences.

Knee-Pain-Cycling

Saddle Height

You may experience pain along the back or outside of the knee when the seat is too high. When you are reaching too far for the pedals, the hamstring tendon and the iliotibial band are overstressed and may become sore.

When the saddle is too low, you may experience pain around the kneecap due to the additional stress on the patellofemoral joint. You saddle should be adjusted to allow for 27 to 37 degrees of knee flexion to reduce overexertion.

Saddle Positioning

Riding with your saddle too far forward can cause pain in the front of the knee. Many riders feel that they can get more power by leaning forward, but it can actually cause unnecessary stress on the patellar tendon.

Moving your saddle back can alleviate some of the pain in your knee. However, a saddle that is too far back can cause pain in the back of the knee due to overextension. If necessary, visit a bike fitting specialist to make sure your seat is properly adjusted.

Foot Placement

Even something as simple as foot placement on the pedals can impact your knee or cause pain. Most commonly, cyclists will experience pain on the inside of their knee. If your feet are too close together or too far apart, the knee is pushed inward or outward during pedaling, causing unnecessary stress on the joint.

When positioning your cleats, align your knee with your feet so the force is directed vertically through your lower leg to avoid excess stress on the knees.

Overexerting Yourself

Any of the knee pain described can also be evident of overtraining. Difficult courses or strenuous hill climbs can take a toll on your body, particularly if you normally cycle on flat ground. Increasing your mileage by more than 10% each week can harm your knees or lead to injuries in other parts of your body as well.

Allow yourself recovery time after strenuous rides, and increase your mileage gradually to reduce the risk of injuries. Most of all, seek treatment when necessary and give yourself time to relax.

Treatment for Knee Pain

Dr. Heiden was an Olympic athlete and understands the risks and rewards associated with pushing yourself. Cyclists who experience knee pain can seek treatment from an experienced doctor who understands non-surgical and surgical treatment options. Your treatment may include:

  • Rest and relaxation at home for minor injuries
  • Pain medication
  • Physical therapy
  • Surgery

In addition to treatment, it is recommended that you make appropriate adjustments to your bike and riding techniques in order to avoid future injuries. Dr. Heiden will create a customized treatment plan to alleviate your knee pain and help you get back on your bike as soon as possible.

19 Comments


Great Article
Thank You
Dante

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Great info, especially the need to find a professional, highly experienced bike fitter!

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I like what you said about making sure you’re not overexerting yourself to avoid knee pain. My brother recently got in a cycling accident and will probably have to go to an orthopedic surgeon. I hope that he can get the treatment he needs for his knee injury so that he can continue to be active and exercise.

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    Richard,
    Thanks for your question. Bike adjustments for knee pain can really vary depending on the location of pain in the knee. For example, riding with the saddle too far forward can cause pain in the front of the knee; whereas poor cleat alignment may be causing pain on the inside of the knee. We recommend seeking out a professional bike fitter to ensure proper alignment to alleviate knee pain – it’s worth the time! Most bike shops will be able to help you make adjustments or guide you towards a trained professional. Hope this helps!

    Reply

    Margaret,
    I’m not sure there are specific bikes for arthritis (though there could be), but a hybrid bike can be extremely helpful for someone with arthritis. Hybrid bikes often require less strenuous pedaling, which can be easier on your joints. Another option would be a recumbent bike. The seat on a recumbent bike helps to evenly distributes the weight of your body, often relieving the pressure on your shoulder, hip and knee joints. Lastly, there’s an electric bike 🙂 The advantage here is you can take a break when needed, which can help with the strain on your joints.

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I had issues with pain outside the left knee and now it’s going to the outside of my right knee. Is this only caused by cleat adjustment?

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Try PRICE

Pain relief
Rest
Ice
Compression
Elevation

Get bike fit.. still not working see professional

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Thank you for posting this article. I have been a leisure bike rider and active person my entire life. I’m now in my early 50’s and sometimes when I ride even a few miles on slight incline in low gear my knees get irritated and swell. The soreness continues for weeks. I saw a couple orthopedic doctors on this because it was not normal for me. (I broke one of my knees skiing a few years ago, and this is occurring in both knees.) One doctor said he didn’t know what was causing it and the other said OA even though cartilage looks good on X-ray.

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    Kelly,
    I am glad your found our post helpful. Hopefully some bike adjustments can help to alleviate your pain.

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Super helpful post. I am 46 and had a left knee total replacement in July. I have never really been a bike rider, I have always played basketball and softball which helped lead to my OA and early knee replacement. In October I decided to take up bicycle riding with my husband, he is an avid rider. He got me a good bike and he started me out slowly, after getting the blessing of my PT. I started at about 6 miles each ride and have worked up to about 18 to 20 miles a ride, over the last two weeks I have developed this pain on the inside of my right knee leading up to my groin. My husband rode behind me last week and noticed that when my right knee gets to the top of my pedal I angle my knee outward. After speaking with his bike fitter the pain is most likely being caused by my pedals being to close, so we are making that change to see how it goes. So thank you for your comments on foot placement. I will continue to RICE (rest, ice, compression, and elevation) after each ride though until it get completely better.

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    Jamie,
    Thanks for your comment. We are thrilled to hear you’re finding new ways to stay active. We’re lovers of cycling over here 🙂 and it sounds like you have a good coach and riding buddy in your husband.
    We hope the adjustments to your pedals helps alleviate your pain. Happy riding!

    Reply

My pain is different. It is on the inside of my calf close to the knee on both legs. My doctor said I have severe arthritis in both knees although I have never had any direct knee pain. Does this make sense to anyone? I am on a professional indoor recumbent bike and I believe my feet are appropriately placed. Thanks

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Hi I am 53yr can I cycle 20 miles a day in my indoor bike or should I do it every other day.

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    Brenda,
    The safe distance or time spent on a bike is completely individual and dependent on your activity level and health. I would reach out to your Primary Care Physician if you have concerns about how much cycling is safe for you.

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“Dr Heiden was an Olympic athlete…”?? Give me a break… How about “ dr Heiden was the greatest winter Olympian of all time…” thanks Eric for the great memories, as a Norwegian I appreciate the importance of speedskating… Remember sitting on my dad‘s shoulders as a seven-year-old when you received the “Oscar” price in Oslo as the speedskater of the year, probably in late 1980 or so… 😎

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Great article!
I am 48, been cycling for 3-4 years. Grew up as a kid playing hockey, football and frequently wore support braces for patella tendinitis. Now I biked 5000miles last year. 4800 miles the year before and 3000miles before that. Past two years I have been dealing with patella tendinitis in right knee and past few months it’s gone to the left knee as well! Very frustrating. I’ve managed to cope with treatment but also now ride with kt tape AND a patella strap over the tape! It really helps for the long rides but it’s getting expensive and I hate the look of wearing all these bandaids and straps! Any other suggestions to try? Rest obviously helps but the more I rest the quicker I fall back in my training.
Thanks for you advice!

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    Hi John,
    We are so happy to hear you enjoyed our article. As for the concerns you are having about you patella tendinitis, it sounds like you have already been trying a few different treatments. It may be beneficial to try a short course of an anti-inflammatory medication if you are able. Be sure that you are icing your knees for about 20 minutes a few times a day, especially after cycling. It might also be worth getting in to see a Physical Therapist for more targeted treatment modalities. I would recommend working on quadriceps and hamstring stretching. As you stated, of course rest does help, so you could even try some low impact activity modifications such as swimming to keep up with your fitness while giving your knees a break from cycling. If symptoms persist, you could always see your orthopedist for further advice.

    Reply

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